Simple contact form Help

Can someone give me a html code for a simple contact form
like the image below.


thx in advance.

 

Hi I can give yo a script for $20 are you intereste if so PM Me! Thanks

 

any1 do this 4 free just give me the html code needed

 

here you go.
http://green-beast.com/gbcf-v3/
See the demo here:
http://green-beast.com/gbcf-v3/test-form.php


Or

http://www.freecontactform.com/
and demo: http://www.freecontactform.com/demos.php


green rep perhaps? lol..

 

thx and rep added

 

you can give me the code..

 

I can give you the code in php, if you are interested please let me know.
Yes it's free. All I want from you is a prayer :-0)

 

ok thanks.. please give me the code.. that would really help me.. i ll pray for you my freind..

 

Uhhhhh Nice contact form proxywhereabouts.. Great job by sharing this ... Cheers